In the prognostic analysis 56% of those children referred for adenoidectomy (but randomised to the non-surgical group) failed to improve (38% of the children with recurrent AOM and 89% of the children with persistent OME). The primary outcome was failure at 12 months, defined by a set of persisting symptoms and signs. A total of 503 articles were identified of which 10 trials were included in the meta-analysis eight of these were at a low risk of bias and two were at moderate risk. The final selection of eligible studies and the quality assessment were carried out according to standard methods and disagreement was resolved by discussion. Studies eligible for inclusion in this IPD meta-analysis were randomised controlled trials (RCTs) in children up to 12 years of age diagnosed with recurrent AOM and/or persistent OME in which adenoidectomy (with or without grommets) was compared with non-surgical treatment or grommets alone. A number of electronic databases were searched from their inception including the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), metaRegister of Current Controlled Trials (mRCT),, International Clinical Trials Registry Platform (ICTRP), and Google. Then, (2a) to evaluate the overall effect of adenoidectomy, with or without grommets, on OM using individual patient data (IPD) and (2b) to identify those subgroups of children who are most likely to benefit from adenoidectomy with or without grommets. (1) To develop a model to predict the risk of children referred for adenoidectomy having a prolonged duration of their OM. There is clear National Institute for Health and Care Excellence guidance for the use of grommets in subgroups of children with persistent OM with effusion (OME), but similar guidance is not available for adenoidectomy, either in persistent OME or in recurrent acute OM (AOM). The surgical procedures offered to children with recurrent or persistent OM are insertion of grommets, adenoidectomy or a combination of the two. Otitis media (OM) is a leading cause of medical consultations, antibiotic prescription and surgery in children.
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